Second ambulance is on its way after public anger at cut

Shetland is to get a second ambulance which will be based at Brae and manned by a retained crew, the first scheme in the UK to be run this way.

The announcement was made on Tuesday when Scottish Ambulance Service (SAS) chiefs visited Shetland, and follows mounting public concern about the isles having only one A&E ambulance.

A report before NHS Shetland’s board meeting revealed that there were 43 occasions last year when the ambulance had not been available, and that Shetland consistently delivered worse response times than Orkney and the Western Isles.

Recruitment and training of the retained crew will start immediately, and it is hoped to attract eight people. They will initially be trained to “driver” level by August – this can be done locally. Later they will be trained to “ambulance technician” standard, requiring 11 weeks training off-island.

By August the new £80,000 ambulance will be in Shetland and the recruits will have “patient carrying capability”, having by that time been trained to the basic “first person on the scene” or “first responder” standards.

In another year, by August 2010, they will be fully-trained ambulance technicians, one step below paramedics. The retained team will be dispatched when the full-time staff are unavailable, or their arrival could delay treatment. They will also respond to those calls that are clinically assessed as less serious, leaving the paramedic team, based in Lerwick, available for more urgent cases.

SAS acting chief executive Pauline Howie said: “We are really excited to be able to come up with a solution jointly with NHS Shetland that has been designed to ensure safe and sustainable service provision.”

Meanwhile, ambulance cover will be enhanced by taking a “spare” ambulance in Lerwick back into service with immediate effect.

The spare ambulance is equipped to A&E standards and will be manned by existing staff working additional overtime on a voluntary basis.

When the new ambulance arrives in the summer, the spare will still be retained as back-up for times when either of the ambulances is unavailable or out of action for maintenance.

The new arrangements come in the wake of demands by the public and politicians, sparked by several recent high-profile cases when the ambulance was not able to attend an emergency.

But NHS Shetland chief executive Sandra Laurenson insisted the acquisition of the second ambulance was not brought about by public pressure. “The board is pleased there is going to be a second ambulance,” she said. “We have been working with the ambulance service on this for some time.”

Ms Howie said: “The plan is the result of several months of development and innovation and recognises the changes in demand and service provision that have occurred in Shetland. “We are well aware of Shetlanders’ concerns about ambulance cover and believe this new way of working will make a significant impact, improving community resilience and patient safety.”

She recognised the need for a “quick solution”, and said: “We hope to have the new model up and running as soon as possible. However, it will take some months to recruit personnel and train them to the required standards.”

Ms Howie added that the new arrangements would better enable Shetland to meet the eight-minute response time, the average stipulated for the ambulance.

NHS Shetland chairwoman Betty Fullerton said: “I am pleased that the intensive work undertaken with SAS staff since January this year has led to the positive outcome today. I look forward to the arrival of the new ambulance and support the plan to base it in Brae as this is something we have considered with the ambulance service over a number of years. I also welcome the interim solution which has been offered.”

Public anxiety about emergency provision appeared to have been justified by the revelations made at the board meeting of the 43 occasions in Shetland last year when the ambulance had not been available, and that Shetland performance has consistently been the worst in the three island authorities.

This concern was reflected in a petition calling for a second ambulance and signed by more than 2,000 people which was last week presented to MSP Tavish Scott, who handed it over to ambulance chiefs in Edinburgh.

Organiser of the petition, Malcolm Thomson from Ollaberry, said: “I’m highly delighted common sense has prevailed. It’s a big step and I hope it’s the service Shetland needs. And it shows insight siting it in Brae.”

Mr Scott welcomed the SAS’s admission that the current single emergency ambulance on the Shetland Mainland cannot provide the cover needed.

He said, “The SAS’s own report graphically illustrates that Shetland has the worst response times in Scotland. It shows that Shetland’s concerns over the single ambulance, the concerns of the 2190 people who signed the petition I delivered to the SAS last week, were justified.

“The proposed solution, involving an ambulance based in Brae or thereabouts, seems to make sense. But I want to hear the expert views of the existing paramedics on its staffing. I have asked the SAS repeatedly to ensure that local ambulance staff are included in the planning of the new service. I want to hear that that has happened.”

However the new proposals are not without their challenges. SAS north division general manager Sam Kennedy said that recruiting eight people for retained staff could be difficult, although the service could operate with a minimum of four. There could also be the problem of spasmodic demand on their services when there might not be enough for them to do.

The scheme will cost around £54,000 per year (not counting start-up and training costs) with retained personnel being paid £2,500 annually, plus a call-out fee.

This option for ambulance provision was deemed sustainable by SAS whereas a full-time paramedic service duplicating the existing one was considered not to be. A more expensive scheme at around £369,000 annually, it was rejected as there would have been a problem of “skills atrophy” and trained staff possibly seeking jobs elsewhere to use their skills.

The retained crew scheme destined for Brae will eventually be rolled out in three other remote areas in the Highlands and Islands.

Ms Howie said that if the proposed new service was found not to be viable in Brae it could potentially move back to Lerwick. However, Brae, at the crossroads of the north Mainland, seemed to be a popular choice with board members, especially as SIC convener Sandy Cluness pointed out that there would be a lot of work at Sullom Voe Terminal in the coming years.

Recruits could possibly come from the recently-started First Responders scheme, set up after a visit to the isles by ambulance chiefs in January. That scheme, and one in the south Mainland, will still go ahead, with volunteers expected to be first on the scene after a 999 call. It was stressed by ambulance chiefs that the first response time will not count as an ambulance response time.

The possibility of an ambulance for Brae was raised by Delting Community Council 25 years ago but dismissed when it was decided to concentrate resources in Lerwick.